Nerea a twelve year old is the first born in a family of three siblings. Occasionally she has to take up her mother’s responsibilities whenever she flees her matrimonial home due to her husband’s physical abuse.

Late last year, her mother learnt that these duties were not limited to house chores; Nerea had to fulfil her father’s sexual needs as well. She had presented malaria-like symptoms but was confirmed pregnant when she was taken to hospital.

Nerea opened up to her mother about how the father frequently defiled her. Nerea’s mother confronted her husband and his response confirmed her fears. He threatened to kill both mother and daughter should any of them talk to anyone about the issue.

Information about the defilement somehow got round and in 2016, KMET learnt about Nerea’s case through the Kisumu Gender Technical Working Group WhatsApp group.

It was said that the mother was terrified of reporting the case to the police due to her husband’s constant threats. Fortunately, through the office of the assistant chief, with the help of a social worker, and the community’s paralegal, the girl was successfully rescued.

The paralegal clarified to Nerea’s mother, the legal implications of having Nerea at home without lodging a complaint with the police and she agreed to push through with the legal process. She took her daughter for medical examination at the Kisumu Gender Violence Recovery Centre and thereafter, she recorded a statement with the police.

Nerea* not her real name at Agape Children’s Home weeks after she was rescued from an abusive home.

Due to the sensitive nature of the case, Nerea was admitted at the KMET Freedom House. The Freedom House offers respite, security, emotional support, food, clothes and medical care for adolescents who have undergone gender and sexual violence.

One day during her five-day stay at KMET, she recounted how her father had repeatedly defiled her for months.

“He used to come to my room, put a panga next to my bed and threaten to kill me if I didn’t remain silent. He would then have his way with me,” narrated Nerea.

KMET liaised with Agape Childrens Home in Kisumu to accommodate Nerea to enable her continue with her studies temporarily. She was six months pregnant then.

Agape could not house Nerea for too long as well since they were not fully equipped to host a child with pre-natal needs. She stayed at Agape Children’s Home for a little over a month.

Finally, KMET approached Kiota Homes located in Muranga and the home agreed to take her in until she delivers and gives the newborn for adoption. Nerea’s mother consented to the adoption of the unborn child.

All this while the perpetrator- Nerea’s father was still at large. The Kisumu children’s department advised that the case had to be mentioned in court before Nereah was taken to Murang’a.

A trap was laid for the perpetrator with the help of Kondele police station and he was arrested on 22 April 2016, the same day the case was mentioned. Nerea travelled to Kiota homes and the perpetrator is currently being held at Kodiaga prison awaiting the court process.

However, like KMET and Agape Children’s Home, Kiota Home is just a holding center. After Nerea gives birth, she will have to vacate the home.

When asked what she wanted the most, Nerea had said her biggest wish was to go back to school.

Kiota Home advises that Nerea should be enrolled into a boarding school after she leaves the home but her mother who is jobless cannot afford to take her through school, much less through boarding school. The family’s breadwinner is now in jail but all Nerea wants is to go back to school like girls her age.

KMET has witnessed and handled several incest cases like Nerea’s from Western Kenya ( Betrayal of trust as father impregnates daughter) a fact supported by the 2015 annual crime report released by the Inspector General of Police in March this year. The report singled out defilement as the leading form of morality crime.

Defilement cases rose to 4,495 in 2015 from 3,685 in 2014 and the situation seems to be worsening. This needs to get the conversation started… Are we doing enough as a society to protect our children? What more needs to be done?

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KMET CEO Monica Oguttu (centre) presenting the safe care approach in Kisumu county. To the left is the Minister for health Mrs Ogaja

Public hospitals are always characterized with long queues and grumpy clients with some people even viewing it as a place for only the poor in the society.

It is worse when even the very health providers within the public sector prefer to seek for medical care in private facilities. What went wrong in the public health facilities?

According to KMET CEO Monica Oguttu, reinstating quality is all that is needed to bring back the good name and trust in public facilities.

“Quality is a software that is very important in service delivery but very neglected and never budgeted for” said Monica.

Due to the grave emerging issues in the public health sector as a result of no quality in service delivery, KMET’s safe care initiative to the counties couldn’t be so timely.

KMET has been focusing on quality and health financing issues but in the private sector. However, the glaring need in the public facilities cannot be overlooked.

KMET is therefore currently engaging Kisumu, Siaya, Trans Nzoia and Kakamega counties as a pilot to adopt the safe care model to improve quality in service delivery.

For instance Siaya County has already agreed to start with the county referral hospital before scaling up to six other facilities that were selected for the pilot phase.

Kisumu County on the other hand is in the process of forming a quality improvement team which will oversee the implementation of quality standards in the selected pilot facilities.

During a meeting to discuss the way forward in terms of quality in Kisumu County, the health Minister Mrs. Ogaja ackno

wledged the need to address quality issues in public facilities within

the county.
She complemented the timely venture of KMET and noted that quality improvement actually starts with the management. She also promised her support hoping that Kisumu gets to embrace a culture of quality in service provision.

The journey to bring quality back to public health facilities has already began within the four counties. With the support of policy makers and health stake holders, the light at the end of the tunnel looks so bright.

By Lynette Ouma

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Advocating for women’s and girls’ sexual and reproductive health and rights is not an easy job. Many of us in the field know this going in and manage to stay the course. While others, no matter how passionate they are, lose steam. I remember co-hosting a youth sex education radio show in Montreal, Canada, almost 10 years ago and had to respond to callers who were challenging our right to be on the air. The opposition can be exhausting, even when the work is rewarding.

But recently I met Monica Oguttu (pictured, left), a strong advocate and leader who is making significant advances for girls and is an example of what determination can achieve. Monica is the Founder and Executive Director of Kisumu Medical and Education Trust (KMET), an IWHC partner organization located on the shores of Lake Victoria in Western Kenya. KMET is located in Kisumu County, a region struggling with high rates of adolescent pregnancy and maternal death due to unsafe abortion. Facing poverty, many girls there trade sex for food, school fees, and even menstrual pads. As you can imagine, Monica does not have an easy job.

And many local community leaders are not ready to discuss sexuality. They consider it to be a private matter, and see it as “bad manners” for girls to talk about such a taboo topic. As a result, many girls and young women do not understand their bodies or their rights.

Monica is working to change this by challenging prevailing social norms. Upon returning from the landmark International Conference on Population and Development in Cairo in 1994 — where the international community finally put women’s rights at the center of development — she founded KMET. Monica could not ignore the need for safe abortion and sexuality education in her community. Despite these services being, in her words, “elephants in the house”—necessities that no one recognizes—Monica knew they were essential. Young women and girls cannot reach their full potential without access to critical information and care, that allows them to make informed choices about their lives and bodies. Monica has been a fierce champion of these rights ever since, “the day I stop talking about abortion, is the day I’ll be dead.”

KMET is a force to be reckoned with. The organization supports women and girls in a holistic manner, providing medical, educational, and vocational services. Among other services, they operate a public, youth-friendly clinic and fully-equipped pharmacy. Kenya’s new National Adolescent Sexual and Reproductive Health Policy, launched in September 2015, provides a framework for which KMET can operate and advocate for change.

Monica’s passion and ability to foster dialogue has kept her going. “Advocacy is the oxygen I breathe. When I go to meet my colleagues at the county level, I share stories from the field.” She speaks to girls and women who come to KMET for services and reports their needs directly to policymakers, making sure their voices are heard.

While a fierce advocate, Monica is also known for her ability to promote collaboration between government officials who need to work together to get the job done. Recently she initiated an important dialogue between the county level Ministry of Health and Ministry of Education. Each ministry was blaming the other for the rise in early pregnancies. She mediated a discussion between them, and the result was huge: both ministries agreed to move forward in providing comprehensive sexuality education and committed to allocate resources, train teachers, and monitor the quality of this education.

Monica succeeds because she creates trust and respect between the government ministries and herself, and she’s not afraid to hold them to their promises. It’s organizations like KMET that fight to turn these commitments into reality.

With a leader like Monica, who brings everyone into the fold to solve problems, I know KMET is in good hands. The future is bright for girls and young women in Kisumu. As the holiday winds down, and 2016 starts up, I draw inspiration from Monica’s enthusiasm. She inspires me to keep up my own work to advance women’s and girls’ health and rights.

The emergency contraceptive pill has aroused debates as to whether it can serve as a regular contraceptive method, client’s safety when used more than once in a single menstrual cycle and its side effects.

Much as it can be bought over the counter, its access in some places is limited to avoid cases of overdose as well as ectopic pregnancy risks among other perceived side effects.
This is quite a contentious subject given the high rate at which women go for the emergency pills all the time as they live with fear as to what risks to expect.

A recent research conducted by International Consortium for Emergency Contraception (ICEC) cites that using emergency contraceptive pills more than once is extremely safe.According to the research, the ECPs poses no risk of harmful overdose neither does it affect future fertility.

Quite often we are warned against using the ECPs more than twice a year to avoid risks of ectopic pregnancy. According to the ICEC fact sheet, ECPs can be used even more than once within the same menstrual cycle without an increased risk of ectopic pregnancy.

“There are no restrictions on repeated use of ECPs,” states WHO’s 2015 eligibility criteria while the American Congress of Obstetricians and Gynecologists (ACOG) states that “ Emergency contraception may be used more than once even within the same menstrual cycle.”

ECPs function by delaying the ovulation of a woman. If this same individual engages in unprotected sex again after taking ECPs, she is still at risk of pregnancy within the same cycle. She is also still safe to use ECPs again.

While this research could be a relief to many women who find themselves taking ECPs every weekend to avoid pregnancy, it will also be important to ask if it can be used a regular contraceptive method effectively.

The research clearly indicates that ECPs are less effective as a contraceptive method compared to the ongoing methods such as IUCD, implant or even depo. In fact, it says it is only more effective than the condom in preventing pregnancy but does not prevent HIV or any othe sexually transmitted disease.

Much as repeated use of ECPs has been rendered safe, the article acknowledges the efficacy of ongoing contraceptives for a regular method in preventing unplanned pregnancy. In cases where a regular method has failed, forced sex cases and even unprotected sex, one is free to use ECPs regardless of the number of times previously consumed.

‘While women should know that ECPs are less effective than ongoing contraceptive methods and do not protect against STIs, each woman can use ECPs every time she has unprotected sex and wants to avoid unwanted pregnancy,’ cites the report.

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In 2001 Sammy Said and Janet Ogutu were retrenched by a leading international reproductive health NGO, the two nurses decided to invest in their own clinic. They settled on the expansive Nyalenda informal settlement as the site for the new health facility given its large population.

Sammy and Janet named the facility “God’swill Medical Centre” perhaps in acknowledgement of the need for divine intervention in their new venture. After renting two rooms for the clinic, the duo employed two other support staff. The venture began very slowly. Since the facility had no laboratory, patients were referred elsewhere for lab tests.

“At the beginning we only saw five to ten clients a day but today we see up to thirty patients daily, said Sammy, The clinic opens at 8 am and closes at 5pm only on weekdays.”

The game changer came in 2010 when KMET introduced God’swill to a new quality healthcare financing program called the Medical Credit Fund (MCF). KMET had just entered partnerships with PharmAccess Group from Netherlands whose Medical Credit Fund provides loans to doctors and clinics in the private sector, enabling them to improve the quality of their services, develop their business potential and serve more low-income patients.

The MCF program aims to contribute to a healthier investment climate and increase the bankability hence scalability of the private healthcare sector. According to Janet, KMET offered God’swill technical assistance in developing business and quality improvement plans.

“The business plan enabled us to access an initial loan of 500,000 shillings in 2011 which we used to purchase drugs, a centrifuge machine, give the clinic a facelift and set up a laboratory.

A centrifuge machine purchased by the first loan obtained from MCF

The quality improvement plan that KMET supported Godswill to develop, has enabled the facility to improve its documentation, client safety, infection prevention and upholding patients’ rights.

“The MCF program integrates SafeCare, a step-by-step improvement path to a recognition system that promotes quality improvement and bench marking of health facilities,” explains Janet.

In 2012, God’swill received a second loan of 1,000,000 shillings, which enabled them to improve on safety, introduce immunization, offer – cervical cancer screening, youth-friendly services and carry out renovation of the clinic. With an increased client flow, said Sammy, “we are able to employ five new staff including a laboratory technician”.

At the beginning, the clinic made a monthly net income of 200,000 shillings but currently it makes up to 600,000 shillings. Opening hours have been extended to 9 pm in the evening and all day during weekends.

In 2013,the Centre recorded an 11% healthcare service from 14,400 in 2011 to 16,200. With improved quality of services and good reputation, the clientele flow increased prompting Janet and Sammy to apply for a third loan of 1,000,000 shillings for expansion. With this loan, Godswill acquired additional space for maternity services, an observation room and a youth-friendly clinic. Patients seeking healthcare services have increased from 14,400 in 2011 to 16,200.

With improved quality of services and good reputation, the clientele flow increased prompting Janet and Sammy to apply for a third loan of 1,000,000 shillings for expansion. With this loan, Godswill acquired additional space for maternity services, an observation room and a youth-friendly clinic.

Meggy Agola, a certified KMET SafeCare assessor rates God’swill as one of the most improved medium-health facilities in the network of 162 beneficiary facilities in Kenya. “SafeCare has five quality improvement levels and God’swill has gradually improved and we have certified the clinic as a Level 2 facility.

I see this facility reaching the fifth level in a short time” said Meggy. The ultimate goal of SafeCare is full standards compliance or accreditation. To guide facilities along this path, SafeCare uses 13 service elements representing different levels of healthcare delivery ranging from how management is organized to how the cleaning staff operates.

“God’swill has received a third loan of 1,000,000 shillings which we have invested in renovating and equipping additional rooms for maternity’ said Janet. The loan also facilitated procurement of a delivery couch, additional stock of essential drugs, purchasing of beds and resuscitation equipment.

Sammy and Janet have set a target to improve the clinic’s process and systems through computerization and eventually offering in-patient services.

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Linet Ngacho dresses up her baby in a church where a Huduma Poa health provider attended to her and her children.

It is expected that all children below 9 years of age should undergo a series of immunizations against common but preventable diseases like Polio, Tuberculosis, Tetanus, Measles and whooping cough. These maladies can cause death or life-long disability among children, but it does not seem so for Linet Ngacho who has never immunized all the four of her children since birth.

The twenty six year old mother is a subsistence farmer in Misri Village, Chwele Sub County in Bungoma County, which has the largest number of deprived children according to a 2013 UNICEF report.

“None of my children were delivered in hospital and I have never attended any child clinic,” she confessed. Oddly, Linet lives less than two kilometers from Chwele Sub County Hospital, a government facility.

Her first-born is six years old, followed by a four-year-old second born, a three year old third born and a last born of two years.

Change came for Linet at a Huduma Poa outreach site, six kilometers from her home. She got word from a community health volunteer that health practitioners from Bewa Medical Clinic would be offering reproductive and child health services so she brought her children who had developed persistent ringworm with the last-born running a fever.

Beatrice Wafula, a nurse trained on the IMCI protocol who attended to Linet’s children reported that her case was one of ignorance and lack of awareness after immunizing the children who were still eligible.

“It is of great concern that there are mothers who still do not know the benefit of hospital delivery and child health clinics, this is why it is important to have a strong community strategy,” she said.

In addition, Linet adopted an IUCD after receiving family planning counseling saying: “I rarely have time to do other activities, I’ve always been taking care of my babies and I hope this coil will give me some break.”

Studies disclose that many sick children never receive proper assessment and treatment by healthcare providers, and that their parents are poorly advised. For this reason, Huduma Poa Health Network trains member clinics on the integrated management of childhood illness protocol to Improve case management skills of health-care staff and involve the community health volunteers to reach out to people like Linet in a bid to improve family and community health practices.

Homabay governor Cyprian Awiti endorsed a five year family planning strategic plan, the only one of its kind in Nyanza region, supported by KMET in partnership with Homabay county health management team.

While receiving the document from KMET CEO Monica Oguttu, Cyprian expressed his concern about the low contraceptive prevalence rate in Homa Bay which stands at 45.5% against the 58% national rate.

The governor did not hesitate to note the high teenage pregnancies in his county and its related repercussions such as increased maternal mortality and school drop outs.

“This county is also notorious for high teenage pregnancies. I would call upon all partners to work together to curb this menace,” stated the governor.

In response to the concerns raised by the governor, KMET CEO explained that the strategic plan has factored in the needs of young people through youth friendly services.

She also emphasized that with proper budget allocation for family planning by the county government, the issue of commodity stock out would be addressed and a contraceptive prevalence rate of 70% achieved.

“We want women to have choices. They don’t have to go for injectables (depo) all the time when they can access long acting and reversible contraceptives easily. This is only possible if we don’t let this book gather dust in our shelves but implement its contents,” said Monica.

The governor also gave the KMET and Homa Bay County Health management team a go head to disseminate the strategic plan its eight sub counties for all stakeholders to understand its contents.

In his concluding remarks Cyprian applauded KMET’s intervention in Homa Bay and promised his government’s and other partners commitment in implementation of the strategic plan in a bid to reduce the negative maternal indicators in Homa Bay County.

The endorsement of the strategic plan was done at the county health offices in the presence of the Health Minister Lawrence Koteng’, Deputy Directors of health Kevin Osuri and Mr. Waringa and the county health management team.